Carew-Reid, Re [2012] QMHC 30

MENTAL HEALTH COURT CITATION: Re Carew-Reid [2012] QMHC 30 PARTIES: REFERENCE BY LEGAL AID QUEENSLAND IN RESPECT OF CLOUDYE JOY CAREW-REID PROCEEDING NO: No 0311 of 2012 DELIVERED ON: Delivered ex tempore on 14 November 2012 DELIVERED AT: Brisbane HEARING DATE: 14 November 2012 JUDGE: Ann Lyons J ASSISTING PSYCHIATRISTS: Dr E N McVie Dr A S Davison FINDINGS AND ORDERS: CATCHWORDS: 1. That the defendant was of unsound mind at the time of the commission of the offence. 2. That a Forensic Order not be made. MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant charged with a serious assault of a security officer – where defendant diagnosed with Post Traumatic Stress Disorder and Bipolar Affective Disorder – whether defendant was of unsound mind as defined in the Schedule of the Mental Health Act 2000 (Qld) at the time of the alleged offence MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant had a long history with Mental Health Services but had responded poorly to hospitalisation in the past – where defendant did not have a criminal history for violence – where defendant had a good support network –where there was expert psychiatric opinion that a Forensic Order may impair the defendant’s recovery – whether a Forensic Order should be made COUNSEL: J Briggs for the defendant J Tate for the Director of Mental Health J Thomas for the Director of Public Prosecutions SOLICITORS: Legal Aid Queensland for the defendant Crown Law for the Director of Mental Health Office of the Director of Public Prosecutions (Qld) -- 1 of 5 -- 2 A LYONS J: [1] This is a reference by Legal Aid Queensland filed on 1 December 2011 in relation to Cloudye Joy Carew-Reid. Ms Carew-Reid is charged with one count of a serious assault of a security officer at the Princess Alexandra Hospital on 3 November 2010. It is alleged Ms Carew-Reid kicked and spat at the security officer as he was assisting nursing staff to restrain Ms Carew-Reid. [2] In a report dated 22 October 2011, Dr De Silva stated that Ms Carew-Reid currently has a diagnosis of Post Traumatic Stress Disorder (“PTSD”). He also noted a diagnosis of Bipolar Affective disorder and her long history with Mental Health Services for a number of years. It would seem clear that she has a background of sexual abuse as a child, having been sexually abused by her grandfather when she was five. She argues that she was then misdiagnosed with having Bipolar Affective Disorder and given the wrong medication. Dr De Silva noted that she stated that when she was treated with Olanzapine she experienced visual hallucinations and behavioural disturbances. Her first interaction with Mental Health Services was in 2004 in New South Wales when a six-year relationship ended. [3] Dr De Silva indicated that in 2007 she was admitted to the Royal Brisbane Hospital under an Involuntary Treatment Order (“ITO”) and had further admissions in 2008. In 2008 she was admitted under an ITO and was diagnosed with bipolar affective disorder and personality traits. The involuntary treatment order was revoked in October 2008. [4] Whilst she experienced multiple stressors in 2009, she was treated after 2008 by Dr James. Dr De Silva stated that Ms Carew-Reid was again treated at the Princess Alexandra Hospital in October 2009 as she had not been taking medications in the preceding eight months. She had been seeing Dr James who had been providing supportive psychotherapy. The admission in October 2009 was prompted by an Emergency Examination Order (“EEO”) when Ms Carew-Reid believed she was being poisoned by the Council through asbestos in her roof and she believed she had contracted Hepatitis A from dog faeces that had been left on her doorstep. [5] He noted that on admission she was irritable, disorganised and agitated and required admission under an ITO. She was initially nursed in seclusion due to her aggression and expressed grandiose and paranoid delusions. She threatened suicide to staff. By October 2009, however, she was beginning to respond to treatment with Sodium Valproate and settled. She then was given escorted leave and discharged to follow up by Dr James on Sodium Valproate, Olanzapine and Temazepam. [6] Ms Carew-Reid was then admitted again to the Princess Alexandra Hospital between 8 and 13 October 2010, when she was brought in on an EEO once again. Dr Varghese noted again that she was grandiose and entitled, had delusional beliefs and had elevated mood and pressured speech. She expressed paranoid delusions about bodies being buried in her backyard. There was collateral information indicating a two week deterioration in her mental state following the end of a relationship, coupled with stress. Dr Varghese diagnosed a complex presentation with a documented poor response to hospitalisation. He advised keeping her admissions to a minimum duration given her poor response to hospitalisation. Ms Carew-Reid settled rapidly and was discharged early to the care of a friend. -- 2 of 5 -- 3 [7] On 15 October 2010, however, she was brought back to hospital with deterioration in her mental state. She required seclusion as she was aggressive and agitated and disinhibited. Her Quetiapine was increased and she was treated with Diazepam. She remained irritable and verbally aggressive towards staff. [8] On 21 October 2010 her psychotic symptoms resolved and she was given overnight leave. She called the ward following that leave and requested discharge. She was told it was overnight leave only and she was required to return to hospital, at which point she became abusive and refused to return. An Authority To Return (“ATR”) was completed. [9] On 3 November 2010 Ms Carew-Reid was brought back to the Princess Alexandra Hospital by police under the ATR. She presented as labile in mood and staff recorded her mental health state as irritable, entitled and demanding. It was during that presentation that the current offence allegedly occurred. As there were no beds available at Princess Alexandra Hospital she was admitted to the Logan Hostpital and treated with Quetiapine and Propranolol. She once again required seclusion due to her aggression. She expressed anger about how she had been treated by police as well as grandiose delusional beliefs about working for the Australian Federal Police. She requested a transfer back to the Princess Alexandra Hospital. She was transferred back to the Princess Alexandra Hospital on 8 November 2010. She was subsequently discharged to the care of Dr James. [10] Dr De Silva opined that Ms Carew-Reid has a diagnosis of PTSD and that her illness has been characterised by recurrent episodes of psychosis with a mood component. He notes that she has made excellent gains in her recovery through treatment with Dr James. He states that the severe trauma she experienced in the form of childhood sexual abuse predisposed her to significant mental health difficulties in later life, which was compounded by the death of her father when she was 13. She appeared to be functioning well until her relationship ended in 2003 and she developed a depressive episode. [11] Dr De Silva indicated that following further stressors, including estrangement from her family and sexual assault, she appeared to have developed a PTSD characterised by a significant re-experiencing phenomena, intense distress exposed to cues that remind her of her trauma and physiological reactivity on exposure to these cues. He notes she has displayed significant behavioural disturbance in the context of a perceived loss of control. She is particularly sensitive to the loss of control due to her history of trauma. [12] Dr De Silva considers her primary diagnosis is that of PTSD but acknowledges the diagnosis of Bipolar Affective Disorder. [13] Dr De Silva considers that in the period leading up to the alleged offences in November 2010, Ms Carew-Reid was suffering from an exacerbation in her PTSD and was experiencing a relapse of her psychotic episodes and she was likely acutely distressed at the loss of control she experienced by being handcuffed and being brought into hospital by police. She believed that she was going to be given medication which would cause her to hallucinate and in her heightened state of distress she experienced disassociation as she had done previously at times of trauma as a coping strategy. She has no recollection of spitting at the security officer and this is likely due to her disassociation at the time. -- 3 of 5 -- 4 [14] Dr De Silva considers that she was impaired in her ability to control her actions and her ability to understand the nature and consequences of her actions. He considers that on the balance of probabilities she was fully deprived of the capacity to know she ought not do the act for which she had been charged. He believes her fear of being given Olanzapine and her distress at being restrained on the background of trauma, PTSD and psychosis would have overridden her capacity to know she ought not do the act. He considers this deprivation was in the absence of acute substance intoxication. He considers therefore that she has a mental health defence. [15] Dr Phillips in her reported dated 30 April 2012 considers that at the time of the offence Ms Carew-Reid was suffering from a state of mental disease or natural mental infirmity as described in s 27 of the Criminal Code Act 1899 (Qld) (“Criminal Code”), namely a relapse of a manic episode of bipolar disorder and PTSD. In her report, Dr Phillips indicated that she did not consider that at the time Ms Carew-Reid was in such a state of mental disease as to deprive her of the capacity to know what she was doing or control her actions. She considers, however, that at the time of the offence Ms Carew-Reid was suffering from a state of mental disease as described in s 27, namely a relapse of a manic episode of a Bipolar Affective Disorder and PTSD. She now considers she was deprived of her capacity to know she ought not to do the act. [16] The assisting psychiatrists’ advice was that I should accept the evidence of Drs De Silva and Phillips that Ms Carew-Reid was deprived of the capacity to know she ought not to do the act. [17] Accordingly, I am satisfied that Ms Carew-Reid was of unsound mind at the time of the commission of the alleged offence. [18] In terms of whether a Forensic Order is required, I note the advice of the assisting psychiatrists, although I note also the force of the submission by the Director of Public Prosecutions. This is a serious offence, there is a long history; this is a complex presentation. However, there is no criminal history for violence. I acknowledge that there is a good support network. Dr James indicates in his most recent report that he sees Ms Carew-Reid every two to three weeks, but weekly if necessary. [19] In this regard I also note, in particular, the evidence of both Drs De Silva and Phillips about their concerns as to whether a Forensic Order is required and whether it would, in fact, assist in her clinical management. Both the doctors have indicated that she has made excellent gains in her recovery through her treatment with Dr James and, in particular, I note that it is considered that a Forensic Order is unlikely to confer further benefit in relation to her treatment and may, indeed, impair her recovery. This is based on the clear nexus between her loss of control and autonomy and the regression of her mental state when confronted with the public mental health system. [20] In the circumstances, based on the advice of the assisting psychiatrists, I consider that in the current circumstances a Forensic Order is not required. However, I do take into account the advice by Dr McVie and Dr Davison that Dr James should develop a crisis management plan. I also note the advice in relation to the steps that should be taken by Dr James and that there should be a plan formulated. I also note the advice in relation to the importance of psychoeducation and particularly Dr -- 4 of 5 -- 5 Davison’s comments that this is a shared project between Ms Carew-Reid, her partner and Dr James to ensure her continued health and well-being into the future. ORDERS: 1. That the defendant was of unsound mind at the time of the commission of the offence. 2. That a Forensic Order not be made. -- 5 of 5 --